07-0020 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00000020
Property Address: 78675 SAGEBRUSH AVE
APN: 646-311-017-17 -000000-
Application description: PLUMBING
Property Zoning: MEDIUM DENSITY RES
Application valuation: 3500
Applicant:
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING &"SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B license No.: 751389
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm -under penalty of perjury that I am exempt from the Contractor's State License Law for the _
following reason (Sec. 7031 .5, Business and Professions Cod6: Any city or county that requires a permit to
construct, alter, improve, demolish, ocrepair any structure, prior to its issuance; also requires the applicant for the '
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Cade: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, .
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
( I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). -
( 1 I am exempt under Sec. , BAP.C. for this reason
ate: � / C7 caner.
.CONSTRUCTION LENDIN AG Eor
I hereby affirm under penalty of perjurythat there is a construction lend age che performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMr`r,.
Owner:
HARVEY SUSAN
78675 SAGEBRUSH AVENU
LA QUINTA, CA 92253
Contractor:
JC CONSTRUCTION
67325 MISSION COURT.
CATHEDRAL CITY, CA 92
(760)275-6769
Lic- No.: 751389
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/03/07
--------------_---------------------------------
WORKER'S COMPENSATION DECLARATION --
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
' issued.• -
- I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 229-0024928
VL certify that, in the performance of the workfor which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I s uld-become subject to the workers' compensation provisions of Section
3700 of the Labor e, I shall
forthwith comply with those provisions.
ate: plicant-.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO OVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL INES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. IN ADDITION TO THE.COST'OF-CO ENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application. '
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission' related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
- within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to'cancellation.
I certify that I have read this -application and state that the above information is correct. I agree to comply with all
city and county ordinances an,p4tate laws relating to bus 'agtconstruction, and hereby authorise representatives
oft co ty to enter upo a above-mentioned grope y for inspection purposes.
i
ate: ' nature (Applicant or Age 1:
LQPERMIT
Application Number 07-00000020
Permit . ... PLUMBING SEWER
Additional desc .
-Permit Fee . . . . 30.00
Plan Check Fee
00'
Issue Date . . . .
Valuation . . .
. 3500
Expiration Date 7/02/07
Qty Unit,Charge Per
Extension
BASE FEE
30.00
--- ---------_--__-----------------------
Special Notes and Comments
SEPTIC ABANDON; SEWER CONNECT
Fee summary Charged Paid
Credited
Due
Permit Fee Total 30.00
00 .00
30.00
Plan Check Total .00
.00 .00
.00
Grand Total 30.00
.00 :00
30.00
LQPERMIT
Bin #
City of La Quinta
Building 81 Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # ^ n
l
Project Address:
Owner's Name: �.
SjAnA
A. P. Number:
Address: (o
Legal Description`.
Contractor:
City,'ST, Zip: Ll1Z-L�
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New. Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 't>
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed ready fortCoYrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2°" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" Review, ready for, correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
s
Total Permit Fees
_.
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